December 24, 2014

Summary of Revisions – ADA 2015 Guidelines

The new 2015 American Diabetes Association Guidelines are posted. I have been checking daily for the last week and this morning (Dec 23, 2104), they were up. There are few significant changes and most are minor updates. This is not a complete list.

The “Standards of Medical Care in Diabetes—2015” should still be viewed as a single document, but it has been divided into 14 sections, each individually referenced, to highlight important topic areas and to facilitate navigation. The supplement now includes an index to help readers find information on particular topics.

The BMI (body mass index) cut point for screening overweight or obese Asian Americans for prediabetes and type 2 diabetes was changed to 23 kg/m2 (vs. 25 kg/m2) to reflect the evidence that this population is at an increased risk for diabetes at lower BMI levels relative to the general population.

The physical activity section was revised to reflect evidence that all individuals, including those with diabetes, should be encouraged to limit the amount of time they spend being sedentary by breaking up extended amounts of time (>90 minutes) spent sitting.

Due to the increasing use of e-cigarettes, the Standards were updated to make clear that e-cigarettes are not supported as an alternative to smoking or to facilitate smoking cessation.

Immunization recommendations were revised to reflect recent Centers for Disease Control and Prevention guidelines regarding PCV13 and PPSV23 vaccinations in older adults.

The next item I do not agree with, but it says - The ADA now recommends a premeal blood glucose target of 80–130 mg/dl, rather than 70–130 mg/dl, to better reflect new data comparing actual average glucose levels with A1C targets.

To provide additional guidance on the successful implementation of continuous glucose monitoring (CGM), the Standards include new recommendations on assessing a patient’s readiness for CGM and on providing ongoing CGM support. Here the ADA missed a golden opportunity to insist that the Centers for Medicare and Medicaid Services (CMS) allow and pay for continuous glucose monitors for those over the age of 65.

ADA did a good thing when they said, to better target those at high risk for foot complications, the Standards emphasize that all patients with insensate feet, foot deformities, or a history of foot ulcers have their feet examined at every visit.

This does not include all the changes and you may read the entire sections here. The 2015 ADA Guidelines Table of Contents can be accessed at this link.

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